Are we all born with a twin?

The odds of having once been a twin are higher than many realise. The rate of twins among live births is only about 1.3%. But as many as 12% of all naturally conceived pregnancies may begin as twin pregnancies, according to one study.

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Judith Hall, professor emerita at the University of British Columbia, has been studying twins for 50 years and is considered a world authority in genetics and pediatrics. Her daughter believes she was an identical twin, although Hall herself had no indications at the time. "She knows that she had a twin. She has dreams about it," says Hall simply.

However, Segal is sceptical about prenatal memories of a lost twin.

"It's a romantic notion," she says. "As a scientist, I remain open to the evidence that it could be possible, but so far I've not seen it. In all the twins I've studied who were raised apart [after being separated at birth] not one of them thought they were a twin. They were as surprised as we were."

When two becomes one

There are various hypotheses as to why a twin vanishes.

"It could be that something is wrong with one fetus, or perhaps the mother doesn't have enough room," says Segal. "The womb was designed for one baby, not two. It could simply be a correction to ensure the health of the twin who survives." If a twin disappears before 12 weeks, it is unlikely the mother would know because ultrasounds are rarely conducted that early. "In medical terms, it is called 'vanishing twin syndrome' because at an early ultrasound there are two heartbeats, but later one of them seems to disappear," says van Dongen. "However, those who have lost a twin pregnancy prefer to call it a stillborn pregnancy." Sometimes there are visible remnants of the other twin. A rare phenomenon known as fetus papyraceus or 'paper doll fetus' describes a mummified fetus that died before the age of 10 weeks. It is flattened between the membranes of the living twin and uterine wall. It occurs in one in 12,000 pregnancies. "It is like a small piece of parchment that looks like a tiny baby," says Craig, the twin researcher. An even rarer occurrence is called fetus-in-fetu or a 'parasitic twin', when one twin is absorbed inside the other, and parts of that twin remain in the other. "Quite often, there's a structure that resembles a spine. And there can be hair and parts of a limb," says van Dongen.

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Fetus-in-fetu is extremely rare. It occurs in about one in 500,000 live births and there have been only 200 cases reported globally. "A person may have a lump somewhere that they only get checked out as an adult. You can imagine how surprising it would be if an x-ray reveals that their twin is tucked away in their abdominal cavity," says Craig. In the case of non-identical twins, some of the deceased twin's genetic material may find its way into the surviving twin. In a remarkable case in 2015, a man underwent fertility treatments and the DNA in his sperm turned out to be 90% his and 10% that of his unborn fraternal twin. While he and his twin shared a womb, he absorbed some of his twin's cells, effectively becoming a blend of himself and his brother. The passing of cells between twins or triplets during early development was once considered rare, but is in fact not that uncommon. Around 8% of non-identical twins and 21% of triplets have two blood groups: this makes them a chimera – a fusion of two bodies.

Identical twins – or not?

Even the distinction between identical and non-identical twins may not be as clear as was once thought. For example, it was once believed that identical twins always shared a single placenta, while non-identical twins each had their own placenta. When Sydney-based digital marketer Claire Chow had an ultrasound at 10 weeks, she was told that there were two amniotic sacs and two placentas, and that she was therefore having fraternal, or non-identical, twins. But when her daughters, Madeline (Maddie) and Mia, were born, she noticed that they seemed completely alike. Maddie had a rounder face and Mia had a tiny mark on her nose – those were the only differences. As the girls grew older, strangers kept commenting on how "identical" they were. At the age of four, the twins were DNA tested. They are 99.99% identical.

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